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Physician Mind Shift: The Emergency Department in an ACO World

By Mark Crockett, MD

In the era of accountable care, you’ll notice that many hospitals and health systems are already driving towards more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a fast-paced environment is concerning for physicians evaluating the pay-for-performance model.

In today’s ED, patients may enter with a chronic condition that could be better managed by a primary care physician (PCP), but because ED physicians are incented to treat sick people in a fee-for-service model, they continue to take these patients on instead of referring them outside the ED walls. If instead both ED and primary care physicians operate as part of a team of care givers that are incented to ensure patients stay healthy and avoid hospital admissions and readmissions, they are headed in the same direction in terms of focusing on better patient outcomes vs. reimbursement dollars.

ED physicians used to be among the few physicians employed by the hospital, but that’s changing dramatically as IDNs snap up physician groups. The larger group working together will help make sure the ball isn’t dropped anywhere throughout the spectrum of care. If a patient with a laceration comes into the ED with diabetes, and that ED doc doesn’t think to check blood sugar – because that’s more of a PCP issue – that oversight will be visible in an ACO environment and the physician might be under the microscope in terms of the role played in ensuring quality outcomes.

Part of this movement requires implementing integrated technology solutions that provide greater visibility into the types of care needed in your community, allowing the health system to build care facilities that are catered to the population it serves, ultimately enabling the sustainable health community. But the real lynchpin for success is the collaboration between people, not just IT systems. This means choosing metrics to support each constituency that has a stake in the game – providers, payers, physicians and patients – so that they buy into the new strategy and are empowered to make changes that support lower costs, increased efficiencies and higher quality care. It takes strong leadership demanding teamwork across clinical, administrative and even third-party vendors, along with a shared passion for making sure patients are cared for in the best possible way to make this happen.


Mark Crockett, MD, is chief medical officer for Accountable Care Solutions at OptumInsight. He also practices emergency medicine at Advocate Good Samaritan Hospital in Downer’s Grove, Ill. He maintains a solid understanding of the day-to-day workings of an emergency department and the need for automating the documentation process of this intense environment.

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